A Randomized Controlled Trial of Ultrasound Versus Nerve Stimulator Guidance for Axillary Brachial Plexus Block

Barrington, Michael J.; Gledhill, Samuel; Kluger, Roman; Clarke, AE; Wong, Daniel M.; Davidson, Henry; Thomas, Rod

doi:10.1097/aap.0000000000000486

Cited by 76 publications

(6 citation statements)

References 14 publications

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“…A randomized controlled trial indicated no difference in the efficacy of axillary BPB performed by novices when using ultrasound guidance vs. the NS technique. 19 Axillary blocks with US guidance exhibited similar success rates and complication rates as NS guidance. 20 Our study demonstrated the feasibility of a BPB rat model and confirmed the efficacy and safety of BPB under NS-guided conditions.…”

Section: Sensory Blockadementioning

confidence: 80%

A rat model of nerve stimulator-guided brachial plexus blockade

et al. 2018

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It is important to develop a feasible animal model of regional anesthesia other than sciatic nerve blockade for pharmacokinetic investigations of new local anesthetics or analgesia in upper extremity surgery. Herein, we explored a nerve stimulator (NS)-guided brachial plexus block (BPB) in a rat model. The anatomy of the brachial plexus in rats was delineated in cadavers, and various BPBs were examined. The puncture point was located 0.5-1.0 cm below the lateral one-third of the clavicle. The efficacy and safety of the NS-guided BPB were evaluated using an injection of 2% lidocaine or 0.5% bupivacaine in 16 live animals; saline injection was used as a control. Both sides of the brachial plexus were located successfully using the NS-guided technique. Sensory blockade (nociception assessment) and motor blockade (grasping and straightening tests) appeared after application of the two classical local anesthetics, but not normal saline. The motor and sensory blockade induced by bupivacaine exhibited a longer duration than that induced by lidocaine ( p < 0.05). All rats recovered uneventfully from general anesthesia and BPB. No abnormal results were found in pathological studies or behavioral observations. Thus, a rat model of NS-guided BPB was established, and BPB induced an overall reversible sensory and motor blockade in the thoracic limbs. Evaluation of the efficacy and safety demonstrated that this rat BPB model was feasible, reproducible, and safe.

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Section: Sensory Blockadementioning

confidence: 80%

A rat model of nerve stimulator-guided brachial plexus blockade

et al. 2018

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“…However, the global rating scale used in our study has been validated multiple times and found to have a high intra‐class correlation coefficient [22], suggesting that scores from single assessors are reliably reproducible compared with other assessors and across sites. We used this scale, as performance is associated with clinical outcomes [11, 23] and had the additional advantage of being feasible to perform in the context of a multinational, multicentre study. While our study showed a trend in the global rating scores and a statistically significant difference in pass/fail scores, we caution against over‐interpretation of proficiency results, as our study was not powered for these secondary outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…However, the global rating scale used in our study has been validated multiple times and found to have a high intra-class correlation coefficient [22], suggesting that scores from single assessors are reliably reproducible compared with other assessors and across sites. We used this scale, as performance is associated with clinical outcomes [11,23] and had the additional advantage of being feasible to perform in the context of a multinational, multicentre study.…”

Section: Severalmentioning

confidence: 99%

Using psychometric ability to improve education in ultrasound‐guided regional anaesthesia: a multicentre randomised controlled trial

et al. 2021

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The learning curve for novices developing regional anaesthesia skills, such as real-time ultrasound-guided needle manipulation, may be affected by innate visuospatial ability, as this influences spatial cognition and motor coordination. We conducted a multinational randomised controlled trial to test if novices with low visuospatial ability would perform better at an ultrasound-guided needling task with deliberate practice training than with discovery learning. Visuospatial ability was evaluated using the mental rotations test-A. We recruited 140 medical students and randomly allocated them into low-ability control (discovery learning), low-ability intervention (received deliberate practice), high-ability control, and high-ability intervention groups. Primary outcome was the time taken to complete the needling task, and there was no significant difference between groups: median (IQR [range]) low-ability control 125 s (69-237 [43-600 s]); low-ability intervention 163 s (116-276 [44-600 s]); highability control 130 s (80-210 [41-384 s]); and high-ability intervention 177 s (113-285 [43-547 s]), p = 0.06. No difference was found using the global rating scale: mean (95%CI) low-ability control 53% (95%CI 46-60%); lowability intervention 61% (95%CI 53-68%); high-ability control 63% (95%CI 56-70%); and high-ability intervention 66% (95%CI 60-72%), p = 0.05. For overall procedure pass/fail, the low-ability control group pass rate of 42% (14/ 33) was significantly less than the other three groups: low-ability intervention 69% (25/36); high-ability control 68% (25/37); and high-ability intervention 85% (29/34) p = 0.003. Further research is required to determine the role of visuospatial ability screening in training for ultrasound-guided needle skills.

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“…In a study designed to determine the sensitivity of paresthesia and electrical nerve stimulation for identification of needle-to-nerve contact during the performance of peripheral nerve blocks, 17 the sensitivity of paresthesia with an insulated needle was found to be 38.2%, whereas the sensitivity of a motor response with 0.5 mA or less was 74.5%. While nerve stimulation can be equally effective and safe in nerve block placement in novice and experienced practitioners, 18 it is generally accepted that currents between 0.2 and 0.5 mA could not rule out intraneural needle position and a stimulation current of 0.2 mA or less is specific for intraneural placement of the needle. 19 Since nerve stimulation in general, is associated with low sensitivity and high specificity for localizing nerves, it has transitioned from being the sole tool of nerve localization to mostly being used as a monitor against needle-nerve contact.…”

Section: Anatomic Landmarks and Nerve Stimulationmentioning

confidence: 99%